Provider First Line Business Practice Location Address:
8141 W CAMELBACK RD
Provider Second Line Business Practice Location Address:
STE #3
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85033-1050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-848-9100
Provider Business Practice Location Address Fax Number:
623-247-3917
Provider Enumeration Date:
04/28/2006